Justification

Nonsubstantive Change Request

ICR 1405-0211

DS-5528 – Evacuee Manifest and Promissory Note

Justification: The Accounts Receivable Branch Accountant, U. S. Department of State, Bureau of the Comptroller and Global Financial Services advises that effective September 30, 2025, their lockbox in St. Louis Missouri will be closing and consequently the payment and collection address information on the DS-5528 form will need to be updated as described below. In addition, CGFS requests removing PII information (date and place of birth and Social Security number) from collection/repayment correspondence and checks or money orders (date of birth and Social Security Number) and that the forms reference Pay.gov and the Accounts Receivable web page. Accounts Receivable provides the debtor with the account number in the initial billing.

Changes to the form on Page 2, Item 89, Part 2.  Paragraph 4

Current Text:

4.  I will include my name, date of birth, place of birth, and Social Security number with all correspondence, payments, and questions.  I will make payment to the Department of State, Accounts Receivable by credit/debit card, check or money order payable to Accounts Receivable Branch, PO Box 979005, St. Louis, MO  63197-9000.  Send questions by mail or courier (DHL, FedEx, UPS, etc.) to:  Accounts Receivable Branch, Comptroller and Global Financial Services, Department of State, 2010 Bainbridge Ave., North Charleston, SC  29405.  To make inquiries by telephone:  From the U.S. or Canada, call 1-800-521-2116 or internationally, call 843-746-0592.  To make inquiries by email, contact:  [email protected].  

DS-5528 Draft Revised Text:

4. I will include my name and account number with all correspondence, payments, and questions. I will make payments using Pay.gov. In Pay.gov, enter REPAT in the search field. Questions can be sent by mail or courier (DHS, FedEx, UPS, etc.) to the following: Department of State, Accounts Receivable Branch, 2010 Bainbridge Ave., North Charleston, SC 29405. To make inquiries by telephone: From the U.S. or Canada, call 1-800-521-2116 or internationally, call 843-746-0592. To make inquiries by email please contact [email protected]. Further information can be found at https://cgfsaccountsreceivablebranch.state.gov/.

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